End of Public Health Emergency and Its Impact on Appendix K

From a Direct Support Professional (DSP) crisis that was already rising before the pandemic to a need for more waiver slots which has been an advocacy platform for many disability advocates, COVID-19 actually increased the issues that have been experienced by the disability community for years.

The U.S. federal government declared a Public Health Emergency early on during the pandemic in 2020, which allowed for extensions and enactment of programs that were able to provide more resources and relief. Among those was Appendix K that allowed states to request amendments to approved Home and Community Based Waivers (HCBS) 1915(c) Waivers. 

According to Medicaid, it included actions that states can take under the existing Section 1915(c) home and community-based waiver authority in order to respond to an emergency.  Other activities may require the use of various other authorities such as the Section 1115 demonstrations or the Section 1135 authorities. 

In Georgia, it affected the Independent Care Waiver Program (ICWP), Comprehensive Supports Waiver Program (COMP), and New Options Waiver (NOW). 

Appendix K being approved was able to extend services for individuals that receive the waiver(s),” said Naomi Williams, Founder and CEO of Exceptional Living 101. “When the public health emergency went into effect, it allowed for the government to not be bound to rules and procedures you normally have to go through.”

“Specific to HCBS waivers, one of the many things it allowed was payment for family hire. Typically if a family member, say a mom or dad, could not be paid personnel, they couldn’t be paid to take care of their son or daughter. But under Appendix K because of the shortage of direct support personnel, family members could be paid as caregivers,” added Williams. 

The Public Health Emergency officially ended on May 11, 2023, which will have a direct impact on Appendix K. 

Making a Difference magazine interviewed Brian Dowd, Deputy Executive Director of Policy, Compliance and Operations Office Medical Assistance Plans at the Georgia Department of Community Health to explain what the ending of the Public Health Emergency means for people with developmental disabilities in Georgia. 

Making a Difference (MAD): What does the end of the Public Emergency mean for the people of Georgia? 

Brian Dowd: Hopefully, the end of the Public Health Emergency means that life for the people of Georgia can get back to normal. It also means that some conditions and provisions allowable during the Public Health Emergency will be coming to a close.

MAD:  How does it impact services and support for people with developmental disabilities in Georgia? Specifically, Appendix K?

BD: Appendix K provisions are specific to Home and Community Based Waiver Programs.  Provisions of Appendix K are allowed for six months post the Public Health Emergency. In this case that means November. Any Appendix K provision would need to either be incorporated permanently through a Waiver amendment or they would sunset in November. Outside of Appendix K, continuous enrollment in Medicaid has come to an end; and annual Medicaid redetermination began in May. All Medicaid members will resume eligibility determination to ensure their eligibility as before the Public Health Emergency.

MAD: What should individuals with DD and their families/caregivers be considering as the ending of the emergency could change services and supports?

BD: First and foremost, waiver members who receive their Medicaid eligibility through the Division of Family and Children Services should be on the lookout for any information related to a Medicaid review. They should fill out the information and return it as requested via one of the available options for return. Also, make sure your address and contact information is updated either at the Division of Family and Children Services or through the Social Security Administration. Finally, get in touch with your Support Coordinator prior to the expiration of Appendix K provisions to ensure that your service needs are appropriate and continuing as normal post Appendix K expiration.

MAD: Are there ways the Department is working to keep some of the Appendix K benefits that have helped families in the long run?

BD: Yes.  The Department of Community Health and the Department of Behavioral Health and Developmental Disabilities are reviewing all provisions of the Appendix K.  Some of the rate increases enacted during the Public Health Emergency as well as telehealth provisions have been made permanent already. We also recommend that everyone continue to stay in touch with Support Coordination for additional information. 

For more information, visit the Department of Community Health.